It really won't HRT a bit

The quantity of news reporting on hormone replacement therapy
(HRT) and related women's health issues has increased in recent years. The quality of
the coverage is another story. All too often, researchers note, reports on these topics in the
popular press suffer from an excessively negative viewpoint and a dearth of statistical
perspective.

Dr. Rogerio Lobo, Willard C. Rappleye Professor and chairman of obstetrics and gynecology at
Columbia, says news articles on HRT typically lack balanced coverage, reporting on a single
study or a single point of view. Reports associating long-term HRT with an increased chance
of breast cancer often discourage women who could benefit from this treatment. However, few
articles mention that lung cancer, not breast cancer, is the leading cause of cancer deaths
among women.

An April 11, 1998, report in the St. Louis
Post-Dispatch about tamoxifen, a synthetic drug prescribed for prevention and
treatment of breast cancer, does compare breast and lung cancer statistics, but like many such
articles it overlooks a pertinent fact: About six times more postmenopausal women die from
heart disease than from breast cancer. "The negative spin is scary," says Dr. Lobo. "It's not an
incentive to start or continue therapy. It seems like they always choose to report the
sensational, the negative, which is a great disservice. People stop using things because of fear."

A cliché holds that a good journalist is a good generalist, but "the lay press often
cannot evaluate complex scientific reports," says Dr. Michelle Warren, medical
director of Columbia's Center for
Menopause, Hormonal Disorders and Women's Health and professor of medicine and of
obstetrics and gynecology. Many reporters apparently are unable to sift the important facts
from the data they are supplied. Press releases issued by drug manufacturers often contain
information that doesn't make it into published reports.

For example, news articles about tamoxifen regularly mention that long-term use can double a
woman's risk of endometrial cancer. The report published July 10, 1998, in the New York
Daily News is typical, neglecting to mention that this is a highly treatable form of
cancer that usually strikes one in 1,000 women in the general population, or two in 1,000 in
the tamoxifen study. Depending on her family medical history, a woman might be willing to
consider treatment if she were clearer about the odds.

"It's probably not the fault of the media," says Dr. Ethel Siris, Columbia's Madeline
C. Stabile Professor of Clinical Medicine. "Scientifically, we don't have all the answers. The
information given by experts can be confusing." However, she agrees that "the media often
take a dramatic approach that scares people. Statistically, more women will die of heart
disease, but breast cancer scares them more. There are a lot of articles on increased risk, while
the opposite point of view or studies that contradict the scarier reports are ignored."

Dr. Warren points out that raloxifene, recently approved by the FDA for treatment of osteoporosis, is routinely--and
inaccurately--described as a "designer estrogen," a term that the drug's manufacturer claims
was coined by the media. "It's causing confusion," states Dr. Warren. "It's not estrogen; it
doesn't do all that estrogen does." Her patients often request drugs by name, regardless of
whether the drug is appropriate for their situation, because of what they've heard in the news.
"There are not data proving that raloxifene is good for the heart, in spite of reports. It has
been approved only for osteoporosis, not for breast
cancer or heart disease." The danger in prescribing a drug for something it might do, rather
than using a tested and approved course of treatment, is that valuable time is squandered.
"You're losing an opportunity to use other treatments," she says.

Surprisingly, all three physicians report that patients have asked for raloxifene and tamoxifen
based on what they've read in financial articles. Whether it's the allure of hooking up with a
projected financial winner or the rosy--if incomplete--portrait sometimes painted in
comparison to estrogen, many women are sure the so-called designer drugs are for them. Dr.
Lobo reports that some patients who have had their interest piqued by business journals have
sought him out for a third or fourth opinion after other physicians have discouraged them
from using a synthetic drug.

"Bright, curious, wealthy people read things," Dr. Siris comments. "But you'd have to be nuts
to ask for treatment based on whether a pill is expected to make a bundle of money. That
doesn't take into account how doctors and patients behave; you don't base care on how much
a pill will make."

There are benefits to increased news coverage of health issues, even flawed coverage, since the
articles provoke thought about the body's changes during aging and bring attention to possible
remedies. "Patients call whenever the articles run," says Dr. Siris. "Whether the coverage is
good or bad, patients ask about drugs and treatments; should they make a change?" The
change most physicians favor is seeing reporters place health stories in more informative
contexts. -- Elzy Kolb